Labor and Delivery

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Labor and Delivery
2011-04-08 01:24:40
Therapeutics Exam6

Therapeutics Exam6 Labor and Delivery Dr. Schultz
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  1. Tx of pre-term labor
    Before 37 weeks

    • Tocolytic therapy:
    • goal is to postpone delivery long enough to decrease chances of probs with prematurity esp pulmonary underdevelopment
    • doesn't decr # of preterm deliveries
    • Allows for time to give corticosteroids to enhance fetal lung maturity
    • Ca+2 is needed for m. contractions to occur

    • Drugs:
    • Mg sulfate - antagonizes Ca to decr uterine activity
    • nifedipine - blocks Ca channels
    • terbutaline - reduces intracellular Ca and reduces uterus sensitivity to Ca - not 1st line! - BBW do not use longer than 48-72 h d/t CV issues and death in mother
    • Indomethacin - prevents arachadonic acid conversion to prostaglandins - Cat D if used for > 48 h or after 34 wks of gestation
  2. Tx of Group B strep infx
    Abx throughout labor and delivery

    • recommendation is Penicillin IV
    • OR
    • ampicillin
    • if Pen allergic, can use cefazolin
    • if Pen allergic with anaphylaxis risk, use clindamycin
  3. Tx of post-partum depression
    • SSRIs or TCAs are 1st line (paroxetine is ok in breastfeeding)
    • other options: venlafaxine, bupropion
  4. Maternal and infant benefits of breastfeeding
    • Maternal:
    • faster recovery from pregnancy
    • faster wt reduction
    • decr chance of breast and ovarian cancer and osteoporosis
    • postpone menstrual periods
    • economic benefit

    • Infant:
    • optimal nutrition source
    • complete composition of nutrients, growth factors, enzymes, immune factors, hormones
    • may decr infx rate
    • decr allergies, otitis media, lymphoma, gastroenteritis
    • decr incidence of constipation
    • may improve cognitive fxn in later life
    • enhanced maternal bonding
  5. Factors affecting drug therapy during lactation
    • Mother:
    • drug dose and duration of tx
    • route and freq of admin
    • metabolism
    • renal clearance
    • blood flow to breasts
    • milk pH (less than blood pH, so traps basic drugs more)
    • Milk composition (lipids)
    • plasma level

    • Drug:
    • PO bioavail
    • molecular weight
    • pKa
    • lipid solubility
    • protein binding

    • Infant:
    • age (newborns more likely affected)
    • feeding pattern
    • amount of milk ingested
    • drug abs, distrib, metab, excr
  6. Ways to reduce infant exposure to medications via breast mild
    always consider if drug is necessary

    • Drug Selection:
    • safety of drug
    • choose meds that are well studied in infants
    • avoid long-acting meds
    • determine shortest length of therapy
    • avoid long-term drug use
    • use topicals if available to lower systemic abs
    • choose meds with poorest oral absorption
    • choose meds with lowest lipid solubility

    • Feeding Pattern:
    • avoid nursing during peak drug conc
    • plan feeding before admin of next dose
    • take once daily meds at night

    • Consider:
    • avoid drug therapy if possible
    • observe infant for s/s of drug tox
    • d/c drugs if benefits don't outweigh infant risk
    • meds that are safe for infants usually safe for breastfeeding mom
    • meds safe in preg are not always safe in breastfeeding
    • give pt info regarding risk of drug ingestion and breastfeeding from reliable resources
  7. Best resources for determining recommendations for drug use in lactation
    • Medications and Mothers' Milk (book) by Dr. Hale and the website
    • Phone advice from Yale-New Haven Hospital Lactation Center
    • Drugs in Pregnancy and Lactation (book) by Briggs
    • LactMed - peer reviewed database